000			03953nam a22006137a 4500
008			210719s20212021 xxu||||| |||| 00| 0 eng d
022			_a0003-4975
024			_a10.1016/j.athoracsur.2020.08.066 [doi]
024			_aS0003-4975(20)31888-9 [pii]
040			_aOvid MEDLINE(R)
099			_a33188751
245			_aCardiac Surgery Utilization Across Vulnerable Persons After Medicaid Expansion.
251			_aAnnals of Thoracic Surgery. 112(3):786-793, 2021 09.
252			_aAnn Thorac Surg. 112(3):786-793, 2021 09.
252			_zAnn Thorac Surg. 2020 Nov 11
253			_aThe Annals of thoracic surgery
260			_c2021
260			_fFY2022
260			_p2020 Nov 11
265			_saheadofprint
265			_sppublish
266			_d2021-07-19
268			_aAnnals of Thoracic Surgery. 2020 Nov 11
269			_fFY2021
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
520			_aBACKGROUND: Medicaid expansion (ME) under the Affordable Care Act has reduced the number of uninsured patients, although its preferential effects on vulnerable populations have been mixed. This study examined whether ME preferentially improved cardiac surgery use by insurance strata, race, and income level.
520			_aCONCLUSIONS: These findings demonstrate that the use of cardiac surgical procedures was generally unchanged after ME; however, nonsignificant trend differences suggest a narrowing gap between vulnerable and non-vulnerable groups in ME states. These preliminary findings help describe the association of insurance coverage as a driver of cardiac surgery use among vulnerable patients. Copyright (c) 2021. Published by Elsevier Inc.
520			_aMETHODS: Non-elderly adults (aged 18-64 years) who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or mitral valve repair were identified in the State Inpatient Databases for 3 expansion states (Kentucky, New Jersey, and Maryland) and 2 non-expansion states (North Carolina and Florida) from 2012 to the third quarter of 2015. We used adjusted Poisson interrupted time series to determine the impact of ME on cardiac surgery use for Medicaid or uninsured (MCD/UIS) patients, racial and ethnic minorities, and individuals from low-income areas.
520			_aRESULTS: In expansion states, use among nonwhite MCD/UIS patients had a positive trend after ME (2.3%/quarter; P = .156), whereas use for white MCD/UIS patients fell (-1.7%/quarter; P = .117). In contrast, use among nonwhite MCD/UIS in non-expansion states decreased by 4.4% (P < .001) which was a greater decline than among white MCD/UIS patients (-1.8%/quarter; P = .057). There was no substantial effect of ME on cardiac surgery use for MCD/UIS patients from low- versus high-income areas.
546			_aEnglish
650			_a*Cardiac Surgical Procedures/sn [Statistics & Numerical Data]
650			_a*Medicare/og [Organization & Administration]
650			_a*Patient Protection and Affordable Care Act
650			_a*Procedures and Techniques Utilization/sn [Statistics & Numerical Data]
650			_a*Vulnerable Populations
650			_aFemale
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aRetrospective Studies
650			_aUnited States
651			_aMedStar Health Research Institute
651			_aMedStar Washington Hospital Center
656			_aMedStar General Surgery Residency
657			_aJournal Article
700			_aAl-Refaie, Waddah B
700			_aCohen, Brian
700			_aMcDermott, James
700			_aShara, Nawar M
700			_aZeymo, Alexander
790			_aAl-Refaie WB, Cohen BD, Ehsan A, McDermott J, Sellke FW, Shara NM, Sodha N, Zeymo A
856			_uhttps://dx.doi.org/10.1016/j.athoracsur.2020.08.066 _zhttps://dx.doi.org/10.1016/j.athoracsur.2020.08.066
942			_cART _dArticle
999			_c6620 _d6620